Nigeria State Health Investment Project (NSHIP) Qualitative Study on Key Differentiating Factor for Performance
Under Performance Based Financing (PBF) Approach
March 2015
Midline Qualitative Study Findings Report Cameroon PBF Impact Evaluation
Summary
Cameroon is currently implementing a large-scale impact evaluation to investigate the effects of Performance-based Financing on health outcomes within the specific country context of Cameroon. While the impact evaluation is based largely on quantitative analysis using baseline and endline surveys, the impact evaluation team proposed to introduce a qualitative component to the overall evaluation to probe deeper for explanations or explore specific issues that are relevant to the piloting of PBF in Cameroon. The roles of qualitative research imbedded within a PBF impact evaluation are numerous: (i) to determine the set of issues that are relevant to the specific country context; (ii) to construct relevant quantitative measures; (iii) to explore relevant issues in greater levels of depth and detail; (iv) to understand the role of place, time, practices and processes; and (v) to enhance interpretation of quantitative results.
The PBF Cameroon midline qualitative study was focused upon two primary objectives:
1. Experiences in the piloting of PBF at the central, regional and district level: perspectives of decision-makers, policymakers, and providers.
2. Experiential elements of health service delivery at the operational level: perspectives of community leaders and members
The midline qualitative data collection aimed to answer two separate but complementary sets of research questions that addressed the learning objectives of the study:
1. What has been the experience of piloting performance-based financing at various administrative and operational levels of the health system in Cameroon?
2. What has been the experience of health service delivery for health workers and
community members during the first two years of performance-based financing?
Process Monitoring and Evaluation II of Zimbabwe’s Results-Based Financing Project
Introduction
This report presents the second cycle of the process monitoring and evaluation (PME) for the Results-Based Financing (RBF) project in Zimbabwe, formally the Health Sector Development Support (HSDS) Project. The study’s findings demonstrate the linkages between the first and second PME evaluations. The study prioritizes performance of incentivized indicators, quality of care (QoC) and expenditure/payment data aspects of the health system and program.
The overarching goal of the PME study is to help the Ministries of Health and Child Care (MOHCC) and Finance and Economic Development (MOFED), Cordaid, the World Bank Task Team and interested local and international stakeholders learn from the RBF project; make mid-course adjustment to the technical design and operational processes; and enhance evidence-based project management decision making. Given that quantitative performance of health facilities is monitored every quarter, the study seeks to go beyond the quantitative performance trends to better understand qualitative factors at district, health facility, health worker and community levels that explain performance under the RBF project. This PME is an exploration of the causal pathways from implementation to results. It is a study of the links between activities, outcomes and context of the RBF project. In a way, the study unravels the “black-box” of implementation of performance-based financing interventions in a bid to deepen knowledge of the RBF intervention in Zimbabwe and how reality links with the original design and theoretical assumptions with which the Government, Cordaid and the Bank worked when the intervention was conceptualized.
The RBF project design is anchored on three components: 1) results-based contracts, 2) management and capacity building, and 3) monitoring and documentation. It is anticipated that through this project, both supply and demand for health services— particularly maternal and child health—will be significantly improved, contributing to a reduction in maternal and child mortality and morbidity. The project’s monitoring and evaluation activities are currently tracking the performance of incentivized indicators, QoC and expenditure/payment data. While this ongoing analysis has provided very useful insight into the performance of the project to date, it is essential to go beyond the numbers and explore the underlying processes and dynamics in the trajectory of change. For example to fully understand variation in performance by facility or district it was essential to explore non-quantitative factors in order to deepen knowledge of RBF so as to improve outcomes further; enhance it for sustainability and future application and adapt to other contexts. See Annex 1 Project Design Summary.